OIFOEF Women Darrah Westrup Ph D Womens Mental

OIF/OEF Women Darrah Westrup, Ph. D. Women’s Mental Health Center Women’s Trauma Recovery Program National Center for PTSD VA Palo Alto Health Care System womenvets. PTSD. va. gov darrah. westrup@va. gov

OIF/OEF Women ª What do we need to know about OIF/OEF women? ªHow are they different? ªWhat are their particular treatment needs? ª How can we best serve OIF/OEF women? ªWhat services are needed? ªWhat are the effective treatments?

Women Veterans ª Women are one of the fastest growing segments of the veteran population. They comprise: ª ª 15% of active military 20% of new recruits 17% of reserve and National Guard 13% of OIF/OEF troops (59 casualties as of April ’ 06) ª 5% of 27 million veterans are women and this number is expected to increase to 10% by 2010 ª Women veterans have greater health problems than their nonveteran female counterparts ª 87% of women veterans do not use VA care

Specific Needs of OIF/OEF Women ªLess in-service social support ªDifferent ªRole determinants of social support transition ªIntimate partner violence ªBehavioral ª 29% health of OEF/OIF women veterans who use VA are diagnosed with mental health disorders ªPTSD – SUD comorbidity

OIF/OEF and Family ª Family issues are paramount Often in caregiver role ª Partner conflict ª Parenting skills ª Domestic violence ª Young children ª Individuation from family of origin ª

OIF/OEF Women: Presenting Problems Comorbid Difficulties Depression ª Anxiety/panic ª Substance use ª Personality disorders ª Somatization ª Sexual dysfunction ª Eating disorders ª Self-injurious behavior ª

Military Sexual Assault ª Higher rates of Military Sexual Trauma ª Physical attacks and sexual assaults of women by comrades exceed casualties by enemy actions. ª As many as 25% of military women have been sexually assaulted. ª Sexual assaults and harassment that occur in military may be more damaging than other work settings.

MST is associated with Increased suicide risk ª Major depression ª PTSD ª Alcohol/drug abuse ª Long-term sexual dysfunction ª Disrupted social networks ª Occupational difficulties ª Asthma ª Breast cancer ª Heart attacks ª Obesity ª

Combat-related Exposure Problems similar to those for sexual assault ª Drug-related disorders ª Accidental deaths ª Higher level of general psychiatric distress ª More frequent somatic complaints ª Anxiety/panic ª PTSD ª

Service Model Designated women’s clinic ª Gender specific services ª Prevention and educational services ª Mental health presence in primary care ª Couples and parent-child therapies ª Drop-in groups with childcare ª Evening hours ª Evidence-based treatments ª

VA Services for Women Only 19% of VA facilities provide any MH services in a Women’s Health Center Space Only 7% of facilities provide any services by a specialized women’s MH team These services will be especially important for the younger, less chronic, women OEF/OIF veterans

Response to Treatment Cason, et al. , 2002

Evidence-Based PTSD Treatments ª Clinical Practice Guidelines (ISTSS) ª ª Cognitive behavioral therapy Pharmacotherapy Group therapy Cochrane Review (Bisson & Andrew, 2005) ª ª ª Trauma focused cognitive behavioral (TFCBT) group and individual therapy, and stress management are effective treatments for PTSD TFCBT is superior to stress management between 2 and 5 months following treatment TFCBT is more effective than otherapies

Empirically-Supported Treatments for Women with PTSD ª Seeking Safety (Najavitz et al. , 1996) For women with PTSD and substance disorders ª Fits Herman’s “first stage” of treatment ª No exposure work ª 24 weekly sessions for 90 minutes ª Group format ª Manualized ª Easily transferable ª

Empirically-Supported Treatments for Women with PTSD (cont. ) ª Cognitive-Processing Therapy (Resick & Schnicke, 1992, 1993) ª Based on Information Processing Theory ª 12 sessions Education about trauma meaning § Cognitive therapy – challenging beliefs § Disclosure about the trauma (written) § Skills building – safety, trust, power, selfesteem, and intimacy §

Empirically-Supported Treatments ª Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999) ª 12 sessions in “building block” format ª Control of private events as the problem ª Self as context rather than content ª Letting go of the struggle ª Commitment and behavior change

Clinical Presentation ª Interpersonal problems ª Social isolation ª Identity disturbance ª Impulsivity ª Emotion dysregulation ª Numbing/dissociation ª Problematic thinking

Clinical Presentation (cont. ) ª They are in despair ª They want better lives ª They deserve our best effort ª “Coping” strategies impede therapeutic growth ª Difficulties can be longstanding and entrenched ª Providers are necessarily impacted by the work

Clinical Factors that Affect Treatment ª Difficulty establishing therapeutic alliance ª Approach based on relationship history ª Blended with familial and military dynamics ª Situation ª Evokes evokes vulnerability issues with “control”

Providers’ Challenge Maintaining a Therapeutic Stance ª Caring for those who can make it difficult ª Managing the negative impact ª On oneself ª On the patient or client ª On other patients/clients

Strategies to Help Maintain a Therapeutic Stance ª ª Protect your compassion ªLanguage matters ªNo need to be “above it all”, get support ªExpect to fall from grace Be rigorous ªBe intentional vs. reactive ªBe aware of your limits Human behavior is purposeful ªEven illogical behavior has a function ªFocus on the behaviors vs. labeling Never forget people can and do get better

Program Planning Resources ª Women Veterans Health Program Handbook ª Women of Care ª VA Veterans Health Program Plan Directives ª Mental Health Strategic Plan ª Women’s Mental Health Committee

Suggested References n Kimerling, R. , Ouimette, P. , Wolfe, J. (2002). Gender and PTSD. New York: Guilford Press. n Washington, D. L. , Yano, E. M. , & Horner, R. D. (Eds. ). (2006). VA Research on n http: //siadapp. dior. whs. mil/index. html (Do. D Personnel and Procurement Statistics) n http: //www. defenselink. mil/news/Mar 2006/d 20060316 Sexual. Assault. Report. pdf (Do. D Sexual Assault Report for 2005 with 06 Summary) n Women’s Health [Special issue]. Journal of General Internal Medicine, 21 (3). http: //www 1. va. gov/VHI/page. cfm? pg=32 -- https: //www. eeslearning. net/librix/loginhtml. asp? v=librix (Military Sexual Trauma Veterans Health Initiative) n http: //www. ncptsd. va. gov/index. html (National Center for PTSD).